The Rambler

WASATCH MOUNTAIN CLUB MEMBERSHIP APPLICATION
Please read carefully and fill out all three (3) pages completely.
I am applying for a
___ New Membership
___ Single ___Couple
___ Reinstatement (please do not use this form for yearly membership renewal)
Name of applicant (1) ___________________________________Birth date______________
Name of applicant (2) ___________________________________Birth date______________
Street Address ____________________________________
City, State, Zip____________________________________
Rambler Phone (1) ___________Work Phone(1)_________ Email(1): ______________________
Rambler Phone (2) ___________Work Phone(2)_________ Email(2): ______________________
How did you learn about the WMC?__________________________________________________
Privacy Information: The WMC publishes member’s names, address and phone numbers in the The Rambler,
twice a year to facilitate membership communication. We also occasionally release our address list to WMCboard
approved wilderness and/or conservation organizations for one-off mailings under the stipulation that
they do not continue to use the list or provide it to others. Please select from the following:
___ Please publish my address in The Rambler and provide to board approved organizations.
___ Please publish my address in The Rambler but do not provide to other organizations.
___ Please do not publish my address in The Rambler, and do not provide to other organizations.
Do you wish to receive The Rambler (club publication) ___ yes ___ no.
Membership dues:
$40.00 for single membership ($35.00 dues, plus $5.00 application fee)
$55.00 for couple membership ($50.00 dues, plus $5.00 application fee)
$25.00 for student membership ($20.00 dues, plus $5.00 application fee; must be full-time student, age30 and
under)
Enclosed is $_______ for application fee and first year’s dues. Check and money orders only. Make checks
payable to Wasatch Mountain Club.
Mail completed application to:
Membership Director
Wasatch Mountain Club
1390 South, 1100 East
Salt Lake City, UT 84105-2443
Leave blank for office use:
Receipt/Check # ____________ Amount Received ___________ Date _______ By_________
Membership application (Page 1 of 3)
Board Approval Date___________
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